| NPI | 1104185693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704234170) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704234170) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704234170) | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2025-10-13 |